How therapists can get insurance reimbursement for late claims

That sinking feeling when you realize your therapy claim has been denied because you missed the insurance plan’s filing deadline is all too familiar for mental health clinicians.

Whether you got busy with clients, forgot to include a session, or sent the claim to the wrong address, missing timely filing deadlines can result in claim denials that significantly impact your practice’s revenue.

Fortunately, you may still have options to receive reimbursement from insurance payers, even after deadlines have passed.

Understanding timely filing deadlines for mental health claims

Timely filing deadlines vary by insurance plan, state regulations, and your provider status.

It’s essential to check your specific insurance contracts for accurate information.

For example, in California, insurance plans must allow:

• At least 90 days from the date of service for contracted mental health providers
• At least 180 days for non-contracted therapists

Other states and insurance payers may have significantly different deadlines, ranging from 30 days to 365 days or more.

Filing a dispute for missed insurance claim deadlines

When you’ve missed a filing deadline for therapy services, submitting a formal dispute (also called an appeal) to the insurance plan is often worthwhile.

Many states have laws requiring payers to make exceptions for “good cause” delays.

California law specifically states: “An insurer/plan that denies a claim because it was filed beyond the claim filing deadline, shall, upon provider’s submission of a provider dispute and demonstration of ‘good cause’ for the delay, accept and adjudicate the claim.”

What qualifies as “good cause” for late mental health claims?

While success rates vary by payer and circumstance, these situations may qualify as “good cause” for late therapy claim submissions:

• Provider illness, injury, or hospitalization
• Caring for an ill family member
• Significant personal issues (divorce, death in family)
• Technical problems with electronic billing systems
• Staff turnover or temporary office closure
• Natural disasters or other unforeseen events
• Issues with the insurance company’s claims processing system

Crafting an effective therapy claim dispute

According to Catherine Atkins, JD, staff attorney at the California Association of Marriage and Family Therapists, your claim dispute should include:

1. Complete client information (name, plan ID number, date of birth, Social Security number, dates of service)
2. Clinical documentation showing why the therapy services were medically necessary
3. A statement confirming your delay did not involve willful neglect or misconduct
4. Detailed explanation of the “good cause” for delayed filing with supporting documentation
5. The exact amount owed for the mental health services provided
6. Copies of any relevant communication with the insurance company

Escalating your therapy claim appeal

If your initial dispute is unsuccessful, you have additional options:

1. State Regulatory Agencies: File a complaint with your state’s Department of Insurance or Department of Managed Health Care
2. External Review: Some states offer independent medical review processes
3. Legal Consultation: Consider consulting an attorney specializing in healthcare reimbursement

One therapist’s experience highlights the value of persistence: After an electronically submitted claim was denied for allegedly missing the timely filing deadline, the therapist appealed with proof from the online claims clearinghouse.

When the payer still refused payment, filing a complaint with the state regulatory agency finally resulted in full reimbursement.

Preventing future timely filing issues in your private practice

Implement these best practices to avoid missing deadlines for mental health insurance claims:

• Submit claims within 24-48 hours after providing therapy services
• Use practice management software that flags unbilled sessions
• Conduct monthly audits of outstanding claims and unpaid balances
• File claims electronically whenever possible and save all submission confirmations
• Create a calendar reminder system for approaching deadlines
• Maintain a current reference list of filing deadlines for each insurance panel
• Consider outsourcing billing to a mental health-specialized billing service if administrative tasks overwhelm you
  

  When to seek professional assistance

  If you’re facing complex reimbursement challenges or need guidance crafting effective dispute letters, consulting with a healthcare billing specialist familiar with mental health claims can save time and increase your chances of successful appeals.

  Remember: Even when deadlines have passed, persistence and proper documentation can often lead to successful reimbursement for your therapy services.

  

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